Written by Chris Thom
Spoon Feed
In this retrospective analysis, the novel sonographic assessment of cystic artery velocity showed promise as a predictor of acute cholecystitis.
The cystic artery can provide a clue
This retrospective study analyzed several sonographic variables on radiology-performed ultrasound for determining the presence or absence of acute cholecystitis. The cohort was split into a proven “acute cholecystitis” group after surgery or cholecystostomy tube versus a “no cholecystitis” group, with sonographic variables assessed between them. Particular attention was paid to the test characteristics of peak cystic artery velocity.
A total of 405 adult patients were included in the analysis. There were 65 patients in the cholecystitis group and 340 in the no cholecystitis group. A peak cystic artery velocity of > 40 cm/sec demonstrated a sensitivity of 58.5% and specificity of 83.8% for acute cholecystitis. The presence of gallstones was the sonographic feature with the highest sensitivity (94%), while the positive sonographic Murphy’s sign had the highest specificity (93%). The sonographic feature with the second highest sensitivity was GB distension > 8 cm (87.7%).
How will this change my practice?
This novel sonographic assessment is an interesting addition to what is generally taught and practiced for the differentiation of biliary colic versus cholecystitis on ultrasound. Inflammation of the gallbladder wall can lead to hyperemia and a subsequent increase in the peak systolic velocity in the cystic artery. This has only been studied in the radiology-performed ultrasound realm thus far, and the test characteristics are imperfect, as noted above. However, it is perhaps another piece of the puzzle in more undifferentiated cases and could potentially be added into the global sonographic assessment of cholecystitis versus biliary colic. I will be trying my hand at this with POCUS in the future.
POCUS Pro-Tips and Clips
The identification of the cystic artery arterial waveform is certainly a bit more nuanced than other sonographic features of cholecystitis. To do this, one applies color doppler with a low pulse repetition frequency (PRF) setting to the GB neck area in the long axis. Look for a small pulsatile vessel hugging the anterior GB wall (it may be hard to distinguish from the wall itself). Once identified, place the spectral doppler gate in the vessel and then measure the peak systolic velocity from the tallest waveform. See nearby images for how this should appear during acquisition and measurement.
Source
Ultrasound cystic artery velocity as a predictor for acute cholecystitis in patients presenting to the emergency department. Abdom Radiol (NY). 2026 May;51(5):2398-2409. doi: 10.1007/s00261-025-05216-z. Epub 2025 Oct 13. PMID: 41081877; PMCID: PMC13061786.
